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\title{A Survey on Traditional Medicinal Plants used for the Treatment of Diabetes in Urban Areas of Dhaka and Khulna, Bangladesh}
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             \author[1]{Md. Motiur  Rahman}

             \affil[1]{  University of Dhaka}

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\date{\small \em Received: 8 December 2012 Accepted: 3 January 2013 Published: 15 January 2013}

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\begin{abstract}
        


Diabetes Mellitus (DM) is a metabolic disorder which is greatly prevalent in Bangladesh and the use of traditional medicinal plants for its treatment is also very popular. In this study, a survey to identify the medicinal plants used for the treatment of DM in the urban areas of Dhaka and Khulna, Bangladesh was conducted. In this survey, 100 randomly chosen individuals of both Dhaka and Khulna, 50 each, were interviewed in a structured manner, regarding the use of anti-diabetic medicinal plants. A total of 30 medicinal plants belonging to 18 families were accounted for the treatment of DM in Bangladesh. The most widely mentioned plants were, Coccinia indica (Telachuka), Azadirachta indica (Neem), Trigonella foenum-graecum (Methi), Syzygium cumini (Jam), Terminalia chebula (Horituki), Ficus racemosa (Joiggi dumur), Momordica charantia (Korolla), Swietenia mahagoni (Mahogany)., Phyllanthus emblica (Amloki), Terminalia bellirica (Bohera), Tinospora cordifolia (Gulancha lota), Lagerstroemia speciosa (Jarul), Withania somnifera (Aswagandha). Although a large number of traditional medicinal plants are being used for the treatment of DM in Bangladesh, extensive clinical intervention studies are essential prior to recommend their use to ensure proper public health outcomes.

\end{abstract}


\keywords{diabetes mellitus, traditional medicinal plants, clinical intervention, bangladesh.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
angladesh is a country in South Asia, located on the fertile Bengal delta. It lies between latitudes 20° and 27°N, and longitudes 88° and 93°E. Bangladesh is in the low-lying Ganges Delta. The location of the country allows for the deposition of alluvial soil which has created some of the most fertile plains in the world. The fertile lands of Bangladesh boasted with tropical forests and boggy jungle along with the floral biodiversity made it an excellent source of medicinal plants.\par
Inexpensive and easily accessible nature of the traditional medicines made it an integral part of public health services in Bangladesh \hyperref[b0]{(Ashraf A et al., 1982}\hyperref[b1]{, Ahmed SM et al., 2009}\hyperref[b15]{, Rahman SA et al., 2012)}.\par
I n Bangladesh, the use of traditional medicinal plants for the treatment of DM has not yet been studied in great detail. Hence, the research in this topic has become imperative as the prevalence of DM in Bangladesh is apparently irrupting. Although the prevalence of DM in urban areas is greater than in rural communities \hyperref[b14]{(Rahim MA et al., 2007}\hyperref[b3]{, Bhowmik B et al., 2012)}, the rates for d i a b e t e s has increased from 2.3\% to 6.8\% in between 1999 to 2004 \hyperref[b13]{(Rahim MA et al., 2010)}.\par
It's a burning question now, whether the traditional Ban glades hi medicine provide a safe and effective alternative therapy for DM. In order to accost this question, a survey in urban areas of Dhaka and Khulna was conducted to identify the medicinal plants for the treatment of diabetes. 
\section[{II.}]{II.} 
\section[{Materials and Methods}]{Materials and Methods} 
\section[{a) Study Design}]{a) Study Design}\par
The survey was carried on the Dhaka Municipal Corporation areas which has an area of around 300 square kilometers (km 2 ). According to the Bangladesh Bureau of Statistics, Dhaka metropolitan has a population of about 14.5 millions. T h e infrastructure and socio e conomic stature of the Dhaka city brings about continuous migration of new residents f r o m all over Bangladesh, which contributes to a diverse background of dwellers.\par
The other part of the survey was conducted in the urban areas of Khulna district which has a n a r e a o f 59.57 km 2 and a population of 1.44 millions. It possesses a rural environment with smaller towns as well as a lower population density as compared to the urban areas of Dhaka. 
\section[{b) Data Collection}]{b) Data Collection}\par
The objective of the study was to qualitatively identify traditional anti diabetic medicinal plants, accessible to the g e n e r a l people. Interviews of key informants were performed using a pre-defined questionnaire. A total of 1 00 interviews were conducted, of which 50 in the Dhaka city and 50 in the Khulna city. In this study, participants were divided into different informant groups and key informants were randomly chosen from t h e s e g r o u p s (see Table1). As a limited number of informants w e r e participating in this study,( D D D D ) B\par
Authors ? ? ?: Lecturer Department of Pharmaceutical Technology, University of Dhaka, Dhaka-1000, Bangladesh. e-mai : motiur47@yahoo.com, motiur@du.ac.bd Author ?: Department of Pharmacy, Khulna University, Khulna, Bangladesh.\par
quantitative conclusions are not practicable.\par
Interviews were conducted in t h e Bengali language and grounded on a semi structured question f o r m and the answers were recorded. For the publication of this report i nformed consent was obtained from the participants. In this study, questionnaire was projected to gather information on educational background and social status of the informant, general knowledge about diabetes, accession to allopathic medicine, a n d anti diabetic traditional medicinal plants used in the therapy. In this study, the overall usage rate (\%) of the medicin a l an ti diabetic plants was assessed (see Table \hyperref[tab_2]{2}).\par
Each person participating in the survey was interviewed o n c e and the cited medicinal plan ts were recorded in local names including photographs. The plants listed were dried out, preserved, and finally identified by a phytologist. 
\section[{c) Data analysis}]{c) Data analysis}\par
The usage rate for a plant s p eci es was calculated to assess the incidence of a particular plant species used for the treatment o f diabetes. It was calculated as follow-Usage Rate (\%) = (Number of quotation for a particular plant species/Number of all quotation for all species) *100. 
\section[{III.}]{III.} 
\section[{Results and Discussion}]{Results and Discussion}\par
A total of 100 interviews were conducted which divulged 30 different plants used for the treatment o f d i a b e t e s alone or in combination with other plants. According to the survey, the top five plants used for the treatment of diabetes were, Coccinia indica (Telachuka), Azadirachta indica (Neem), Trigonella foenum-graecum (Methi), Syzygium cumini (Jam), and Terminalia chebula (Horituki). The usage rate of different anti-diabetic medicinal plants is shown in Figure  {\ref 1}.\par
The most frequently cited plants in Dhaka were, Trigonella foenum-graecum (Methi) and Momordica charantia (Korolla); whereas in Khulna, the most frequently cited plants were, Ficus benghalensis (Bot) and Tinospora cordifolia (Gulancha lota). The usage rate of top 13 most frequently mentioned anti-diabetic medicinal plants according to their locations is depicted in Figure  {\ref 2}. The study revealed that leaves, the whole plants, and seeds were most frequently used for the treatment of diabetes (Figure \hyperref[fig_3]{3}).\par
The survey revealed the use of 30 m e d i c i n a l plants of 18 families for the treatment of diabetes in Bangladesh.\par
Coccinia indica (Telachuka) was the plant of choice in most of the cases both in Dhaka and Khulna for the treatment of diabetes. The usage rate of Trigonella foenum-graecum (Methi) is high in Dhaka city. An Anti-hyperglycemic compound-GII by name has been purified from the water extract of the seeds of Trigonella foenumgraecum showed reduced blood glucose in glucose tolerance test (GTT) in the sub-diabetic rabbits. \hyperref[b12]{(Moorthy R et al., 2010)}.\par
Momordica charantia (Korola) is a popular edible vegetables and its usage rate was also high in Dhaka as compared to Khulna. Streptozotocin induced diabetic rats were treated with aqueous extracts of Momordica charantia for a period of 30 days which resulted in a significant reduction in blood glucose, glycosylated hemoglobin, lactate dehydrogenase, glucose-6-phosphatase, fructose-1,6-bisphosphatase and glycogen phosphorylase, and a concomitant increase in the levels of hemoglobin, glycogen and activities of hexokinase and glycogen synthase \hyperref[b17]{(Sekar DS et al., 2005)}. The use of leaves, stem and seeds were a l s o reported f o r the treatment o f D M \hyperref[b7]{(Kadir MF et al., 2012)}.\par
The usage rate of Ficus racemosa (Joiggi dumur) is high in Khulna city. The glucose-lowering efficacy of methanol extract of the stem bark was evaluated both in normal and alloxan-induced diabetic rats at the doses of 200 and 400 mg/kg orally and the ethanol extract (250 mg/kg/day orally) lowered blood glucose level within 2 weeks in the alloxan diabetic albino rats confirming its hypoglycemic activity (Anita Rani \hyperref[b2]{Shiksharthi, 2011)}.\par
Tinospora cordifolia (Gulancha lota) is used highly in Khulna region. Oral administration of the aqueous root extract resulted in a significant reduction in blood glucose \& brain lipids in alloxan induced diabetic rats  {\ref (Patel Nidhi et al., 2013)}.\par
Azadirachta indica (Neem) is a common medicina plant in Bangladesh \hyperref[b7]{(Kadir MF et al.,2012)}. Hypoglycemic activity of the 90\% ethanolic extract of this plant was studied and compared with that of a reference antidiabetic drug glimeperide in glucose loaded and alloxan induced diabetic rats. Result showed that ethanol leaves extract (1 gm/kg) significantly reduced the elevated blood glucose level by 36.91\% in glucose loaded rats and 30.20\% and in alloxan induced diabetic rats, respectively compared to the respective diabetic control group (Rasheda \hyperref[b16]{Akter et al., 2013)}.\par
Anti-diabetic activity has been reported for Terminalia chebula (Horituki). Oral administration of the ethanolic extracts of the fruits significantly reduced blood glucose level glycosylated hemoglobin in Streptozotocin induced diabetic rats (Gandhipuram Syzygium cumini (Jam) significantly reduced blood sugar level in alloxan induced diabetic rats but in case of clinical trials, the extracts obtained from the leaves are pharmacologically inert (Shweta Sharma et al., 2012).\par
IV. 
\section[{Conclusion}]{Conclusion}\par
The socioeconomic structure of Bangladesh allows for the use of a wide range of traditional medicinal plants for the treatment of ailments and our study revealed 30 medicinal plants for the treatment of Diabetes in Dhaka and Khulna, although their efficacy is questionable due to the lack of proper clinical trials.\par
It is, therefore, mandatory to conduct proper clinical trials to evaluate the safety, efficacy, and dose dependant relationship of the plants of interests to ensure better public health outcomes.    \begin{figure}[htbp]
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\caption{\label{fig_1}}\end{figure}
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\caption{\label{fig_3}Figure 3 :}\end{figure}
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\noindent\textbf{} \par 
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\caption{\label{tab_0}}\end{figure}
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\noindent\textbf{1} \par 
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\multicolumn{2}{l}{gluconeogenic enzymes glucose-6-phosphatase}\tabcellsep \multicolumn{4}{l}{extracts using different solvents and their effective}\\
\multicolumn{2}{l}{and fructose-1, 6-bisphosphatase and elevation of}\tabcellsep \multicolumn{4}{l}{doses; International Research Journal of Pharmacy;}\\
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\multicolumn{2}{l}{phosphate dehydrogenase. Biochem J 1993, 292(Pt}\tabcellsep \multicolumn{4}{l}{20. Venkateswaran S, Pari L: Effect of Coccinia indica}\\
1):267-270.\tabcellsep \tabcellsep \multicolumn{4}{l}{leaves on antioxidant status in streptozotocin-}\\
\multicolumn{2}{l}{19. Shweta Sharma, BK Mehta, Darshna Mehta,}\tabcellsep \multicolumn{4}{l}{induced diabetic rats. J Ethnopharmacol 2003,}\\
\multicolumn{2}{l}{Hemant Nagar, and Aditya Mishra; A review on}\tabcellsep \multicolumn{2}{l}{84:163-168.}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{pharmacological activity of Syzygium cumini}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Informant group\tabcellsep \multicolumn{2}{l}{No of persons}\tabcellsep \multicolumn{2}{l}{Gender}\tabcellsep Age\\
\tabcellsep Dhaka\tabcellsep Khulna\tabcellsep Male\tabcellsep Female\tabcellsep \\
Diabetic patients\tabcellsep 20\tabcellsep 20\tabcellsep 20\tabcellsep 20\tabcellsep 55(40-65)\\
Allopathic doctors\tabcellsep 10\tabcellsep 10\tabcellsep 10\tabcellsep 10\tabcellsep 48 (35-50)\\
Traditional healers (Kabiraj)\tabcellsep 5\tabcellsep 5\tabcellsep 8\tabcellsep 2\tabcellsep 60 (45-70)\\
Native doctors a\tabcellsep 9\tabcellsep 9\tabcellsep 10\tabcellsep 8\tabcellsep 43 (35-60)\\
Representatives of local medicine companies\tabcellsep 6\tabcellsep 6\tabcellsep 10\tabcellsep 2\tabcellsep 40 (25-55)\\
Total\tabcellsep 50\tabcellsep 50\tabcellsep 58\tabcellsep 42\tabcellsep \\
\multicolumn{6}{l}{a = Doctors passed from Unani and Ayurvedic Medical Colleges and hospitals;}\end{longtable} \par
 
\caption{\label{tab_1}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.85\textwidth}}
013\\
2\\
Year\\
Volume XIII Issue VI Version I\end{longtable} \par
 
\caption{\label{tab_2}Table 2 :}\end{figure}
 			\footnote{© 2013 Global Journals Inc. (US) © 2013 Global Journals Inc. (US)} 			\footnote{© 2013 Global Journals Inc. (US)} 			\footnote{( )B} 		 		\backmatter   			 
\subsection[{Acknowledgements}]{Acknowledgements}\par
The authors are thankful to all the members who participated in the survey projects and the students of the Faculty of Pharmacy, University of Dhaka, and Department of Pharmacy, Khulna University for actively participating in the survey. 			  			 			 			  				\begin{bibitemlist}{1}
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\end{document}
